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A New Opening for Nurses. People who travel with their eyes open are often able to make suggestions which render travelling both safer and pleasanter for all who come after them. Journeys by sea are to some people very pleasant, and to others the dismalest and most miserable of penances. Especially is this the case when sea sickness adds its terrors to the way. Perhaps a long sea voyage yields its maximum of misery to women who cannot go half a mile from shore without feeling that both the outer world and their inner economy are bent upon having a game at "see-saw," "up and down." At such times ?all past pleasures, and all present comforts, and all future hopes are alike forgotten. The misery of the moment swallows up both past, present, and future. The concentrated ?essence of all imaginable wretchedness discharges itself upon the victim in a ruthless and hopeless deluge of indescribable helplessness and despair. At such a moment a kind woman's presence is desired above all things, and if, in addition to kindness, the woman possesses the skill


BMDICLJRNAL MEGACOLON
The management of megacolon in childhood has been difficult in the past because of uncertainty about its aetiology, but recent reports from workers in Britain and the U.S.A. have led to a rational classification of the condition into symptomatic megacolon, idiopathic megacolon, and Hirschsprung's disease. In symptomatic megacolon a gross obstruction is demonstrable; this may be due to a stricture, stenosis, tumour, or nerve lesion, such as is associated with spina bifida. The treatment, of course, is to remove the cause of obstruction. In childhood cases of idiopathic megacolon form the largest group. The condition is probably acquired as a result of faulty bowel habits, fissure in ano, or other minor causes which lead to gradually increasing passive distension first of the rectum and then of the sigmoid colon. Radiological evidence of dilatation of the anal canal and rectum (terminal reservoir type) or of part or all of the sigmoid colon (tublldar dilatation type) differentiates this group clearly from true Hirschsprung's disease. The condition is essentially benign and responds to persistent conservative treatment, including bowel washouts. Hirschsprung's disease forms the third group in this classification. The abnormality in this serious congenital disorder has been traced to the terminal segment of intestine, which is of normal or slightly narrowed calibre, while above it the bowel is dilated and hypertrophied. Diagnosis now depends on the radiological demonstration of the normal calibre of the rectum and part or all of the sigmoid colon. The pathological changes eluded detection for a long time. Only by microscopical examination of the terminal part of the intestine can it be seen that the ganglion cells of Auerbach's and Meissner's plexuses are missing. The resulting lack of co-ordinated peristaltic movement causes secondary dilatation and hypertrophy of the bowel proximal to the abnormal segment. In the light of this new aetiological conception the rational treatment of Hirschsprung's disease is resection of the aganglionic distal segment by rectosigmoidectomy. Lee and his colleagues' in the U.S.A. have paid a tribute to the work of Bodian, Stephens, and Ward at the Great Ormond Street Children's Hospital for making " intelligent selective treatment [of megacolon] possible." These British workers24 have now demonstrated the essential histopathological lesion in 40 cases. Similar findings have been reported in the U.S.A.,' 5-7 and in this country Burnard8 has discussed the features of the disease in young infants. Swenson and Bill9 were the first to devise rectosigmoidectomy as a treatment for Hirschsprung's disease. Their method was adopted and slightly modified by Stephens,2 working at Great Ormond Street.
The long-term results of this treatment over a period of two to three years have been remarkably good.4 10 Bodian, Carter, and Ward4 have also recently reported a genetic study of Hirschsprung's disease, and though they have not yet been able to define the mode of genetic determination they were able to put forward evidence showing that the chances of a male sibling of a known case developing Hirschsprung's disease were about 1 in 5. The chances of a sister being affected were much smaller. In this disease the length of the aganglionic segment may vary; in a small number of cases it can be considerably longer than the rectum and sigmoid. Bodian and his colleagues point out that a genetically determined disturbance may occur at any stage of differentiation of intestinal nerve cells, which, they suggest, usually proceeds in a cranio-caudal direction. Thus, larger or smaller aganglionic segments would be produced according to early or late interference with normal embryological development.
THE ATOM AND THE CRIMINAL Nuclear physics has just produced a new weapon to beat the murderer. It is a method which will measure the amount of arsenic along the length of a single hair, and so yield a diary of chronic poisoning; and it depends on radioactivation analysis, which was discussed at a recent meeting of the Physical Methods Group of the Society of Public Analysts. The idea is in principle simple enough. An atomic pile produces many neutrons, the particles which along with protons form the greater part of the nucleus of every atom; and the slower moving (" thermal ") neutrons released from uranium in a pile may be captured by the nuclei of foreign atoms on their track. Thus ordinary arsenic contains atoms of a single stable isotope, As75, but when it captures neutrons it becomes a new isotope, radioactive As76, which begins at once to decay and to shoot out electrons (P rays) and y rays, rather like radium. This radiation is characterized in two ways, by the rate at which it is emitted (the decay in this case is half over in 26.8 hours), and by its spectrum-certain specified wavelengths of -y rays, and certain speeds of travel of the electrons. Atoms of the different elements differ in the ease with which they capture neutrons, and this provides the other important variable in the analysis. Arsenic does it particularly well, but many of the atoms composing a hair do not-for instance, carbon, oxygen, nitrogen, and hydrogen. Sulphur is probably the chief competitor, but the decay rate of the radioisotope it produces is quite different, and so is the spectrum of emitted radiation.
In practice, therefore, the suspect hair is exposed to neutrons in an atomic pile, and when it has become suitably radioactive the electrons it emits are studied with a Geiger-Muller counter through various thicknesses of an absorbing filter. Localization is determined by cutting the hair into short lengths, or by moving it across behind a narrow slit in some heavy shielding material, or possibly by its direct effect when laid on AUG. 11, 1951 THE ATOM AND THE CRIMINAL BRITISH 347 MEDICAL JOURNAL an unexposed photographic plate (autoradiography). Less than one part per million of arsenic is easily detected.
This method cannot be used to measure arsenic in body fluids such as blood because of interference from the sodium, Na23, always present, which picks up slow neutrons fairly easily, the resulting Na04 having a halflife of only 15 hours and also enmitting / and -y rays.
It has, however, been used to measure the amount of sodium and potassium inside a single nerve fibre before and after activity. R. D. Keynes described how the nerve was irradiated for a week inside a sealed quartz tube at Harwell, then emptied into a nickel dish and its radiation measured with a Geiger counter, first through a thick filter which passed only y rays from Na24, then through a thin filter which in addition transmitted the powerful /3-radiation from the decay of K42. Radioactivation analysis is thus a very sensitive technique for chemical analysis, likely to have other forensic uses and other applications in medicine.

SODIUM RESORCYLATE
Stockman showed in 1920 that salicylic acid, which is chemically the ortho-form of hydroxybenzoic acid, differs from the meta-and para-forms of this acid in that it alone is of value in the treatment of rheumatic fever. Elsewhere in this issue Drs. Reid, Watson, Cochran, and Sproull suggest that this might be because the -COOH and -OH groups were adjacent and might form a ring by a process called chelation.
They have tested their view by giving y-resorcylic acid to patients with rheumatic fever, since this is an acid in which not only one but two additional rings might be formed. They have found that this acid has a beneficial action and that in amounts of 1 g. daily it is similar in effect to 10 g. daily of salicylic acid.
Unfortunately, resorcylic acid, besides benefiting rheumatic fever, hag various other effects which are drawbacks to its use. After the third day of taking it, four patients showed emotional instability and became confused; they also suffered from pains in muscles and joints. For this reason it is unlikely that resorcylic acid will replace salicylic acid, but the results obtained give support to the hypothesis with which the investigation started.
It appears, moreover, that sodium resorcylate has various actions which resemble the effects of A.C.T.H. and cortisone. For example, Professor Buttle has found that when formaldehyde is injected into the pad of the mouse's foot a swelling of the leg follows. This is reduced when either A.C.T.H. is given or when resorcylic acid is given. This is obviously a promising observation, which suggests that salicylates may act in rheumatic fever by causing a liberation of A.C.T.H. from the pituitary gland. Salicylates are clearly not very efficient in this respect since they do not benefit rheumatoid arthritis to any extent. Nevertheless, the clue must be followed, for it may be the path which leads the way to what so many are seeking-namely, a substitute for cortisone of much simpler structure. CONVALESCENCE Few aspects of medicine have been neglected more than convalescence. The reasons are not difficult to find: when patients are deemed to be "recovered" we turn to new ill patients and leave the cured. But are they recovered ? Are they fully cured ? It is true that some are advised about convalescing and others sent to institutions giving convalescent care, but to assess the results of such care quantitatively and to assess the unsatisfied need for it is a difficult problem. Much is based on clinical observation and the tradition of " Send him to the seaside for a jolly good holiday." Is there any magic in sea air ? It is most difficult for the investigator to find hard scientific facts and give an opinion. A survey' by King Edward's Hospital Fund for London should stimulate further inquiry, for, although this report deals in the main with what might be called the economics of the subject, many striking facts are brought to light from its study of 92 homes giving convalescent care, 19 London hospitals, and 2 provincial hospitals, over a six-months period in 1950. The Health Service does not really face the fact that it should be fully responsible for convalescence, and this has led to much administrative difficulty. When the State took over, only a minority of convalescent homes were included in the Health Service, and contractual arrangements have been made with the others for convalescent care. In the main there are two types of homes-convalescent homes taking patients from hospitals, and recuperative holiday homes taking patients from local health authorities-but the distinction is not clear-cut, which seems unsatisfactory, since it may lead to competition between both services for the available places. Some interesting figures .lend point to this. Of over 4,000 hospital in-patients recommended for convalescence, 65.8% had to wait in hospital or at home for an average of 12+ days. Those patients who spent this wait in hospital caused a loss of 11,140 hospital bed-days. For the corresponding outpatient figures 89.5 % had to wait a minimum average time of 29 days. In the Fund's "summary observations and questions for further study" we find: If the staffing and equipment of a selected number of homes capable of providing nursing care were brought up to a higher standard it may well be that a number of such cases could be discharged from hospital earlier and so release hospital beds which are urgently needed; and: We have noted that the provision of convalescence for children presents special problems and requires more careful and overall planning than it has yet received.
A comprehensive report, to be published, on the convalescent child has recently been completed in the Department of Child Health in the University of Liverpool, and this may throw light on the problems mentioned in the second quotation.
While all the questions presenting themselves to investigators have not been answered in the report, much information of value has been obtained, and we must note with gratitude that the King's Fund in the period 1947-50 expended £230,000 to aid convalescent homes.